Small-bowel obstruction - JSLS

Acute Presentation of Laparoscopic Gastric Band Erosion

SLS — Fri, 27 Mar 2015 15:30:30 +0000

Mohammed A. Bawahab, MD, FRCS (Canada), FASMBS

Department of Surgery, Faculty of Medicine, King Khalid, University, Abha, Saudi Arabia.

ABSTRACT

Laparoscopic adjustable gastric band (LAGB) is a well-established bariatric surgical procedure. LAGB surgery is associated long term with a significant chance for reoperation within 10 years of band placement; 2 causes of reoperation are band migration and erosion. LAGB migration is a common late complication of gastric band, with a reported incidence of as much as 11%. Herein we present a patient with LAGB erosion presenting as small bowel obstruction. In our patient, the LAGB had completely eroded into the stomach and migrated through the pylorus to the upper jejunum, resulting in a small bowel obstruction. We describe our laparoscopic approach and management of this complication, which requires a high index of suspicion.

Key Words: Obesity, Laparoscopic adjustable gastric band (LAGB), Erosion, Complication, Small bowel obstruction.

[gview file=”https://crsls.sls.org/wp-content/uploads/2015/03/jls101153269001.pdf”]

The post Acute Presentation of Laparoscopic Gastric Band Erosion first appeared on JSLS.

Jejunal Obstruction After Complete Transmural Gastric Band Migration

SLS — Sat, 15 Nov 2014 03:51:47 +0000

Florian Primavesi, MD, Tarkan Ja Ìˆger, MD, Michael Baschata, MD,

Dietmar Ofner, MD, MAS, MSc, FACSDepartment of Surgery, Paracelsus Medical University, Salzburg, Austria (all authors).

ABSTRACT

Introduction: Surgery for morbid obesity is constantly gaining popularity around the world, and laparoscopic adjustable gastric banding is among the most accepted standard procedures. Lately, growing evidence for long-term complications has been reported with this particular technique. While band erosion is described in~1% of patients, complete transmural migration is scarce but may lead to acute intestinal obstruction.

Case Description: We present the case of a 55-year-old man with the rare but potentially life-threatening late complication of a complete band migration and consecutive intestinal obstruction 12 years after laparoscopic adjustable gastric banding. Intraoperative findings showed ischemic pressure ulcers and kinking of a small bowel loop due to adhesions and the migrated band device; thus, partial jejunal resection was necessary. The development of a pronounced wound infection required prolonged ambulatory wound care, but ultimately there was no permanent morbidity.

Discussion: Our report aims to raise awareness of possible long-term problems in bariatric surgery, especially after gastric banding. It demonstrates the importance of continuous supervision of obesity patients including regular assessments to avoid and detect complications even years after surgery.

Key Words: Band migration, Laparoscopic gastric banding, Long-term complications, Morbid obesity, Small-bowel obstruction.[gview file=”https://crsls.sls.org/wp-content/uploads/2014/11/13-00158.pdf”]

The post Jejunal Obstruction After Complete Transmural Gastric Band Migration first appeared on JSLS.

Internal Hernia Resulting in Bowel Obstruction After Laparoscopic Colectomy

SLS — Wed, 12 Nov 2014 18:27:22 +0000

Yasunori Yoshimoto, MD, PhD, Akira Tanaka, MD, PhD, Toshihiro Abe, MD, PhD, Takahisa Fujikawa, MD, PhD, Norihiro Shimoike, MD, Seiichiro Tada, MD, Hisatsugu Maekawa, MD, Mitsuo Nishiyama, MD

Kokura Memorial Hospital, Department of Surgery, Kitakyushu, Fukuoka, Japan (all authors).

ABSTRACT

A 65-year-old woman underwent laparoscopic-assisted sigmoidectomy for management of sigmoid colon cancer. Her postoperative recovery was initially uneventful; however, on postoperative day 12, the patient suddenly complained of abdominal pain. Further surgical intervention was finally performed on postoperative day 21 because conservative treatment had been unsuccessful in relieving the obstruction. Laparoscopic surgery revealed that a segment of the proximal jejunum had herniated through an orifice, forming an adhesion between the mesentery of the ileum and the incised retroperitoneum of the mesenteric opening. The obstruction was relieved by laparoscopic adhesiolysis. Only 7 cases have previously been reported where the mesenteric opening has caused an internal hernia resulting in bowel obstruction. This case may suggest the need for closure of the mesenteric opening to prevent this complication after laparoscopic colectomy; however, there is no consensus on whether a mesenteric opening should be closed. Further research is needed to identify the patients who would benefit from the closure of mesenteric defects during laparoscopic-assisted colectomy.

Key Words: Internal hernia, Laparoscopic surgery, Small-bowel obstruction.

[gview file=”https://crsls.sls.org/wp-content/uploads/2014/11/13-00177.pdf”]

The post Internal Hernia Resulting in Bowel Obstruction After Laparoscopic Colectomy first appeared on JSLS.